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<meta name="description" content="昨晚公司请MRC公司（全称是myobrace）的欧大明(Damien O’Brien)老师来进行了MRC的培训，记录一下。以下为我个人记录，不一定代表老师和MRC公司观点（因为是通过同传的）。MRC之前当然也听过，从来没深入了解过，也不知道具体情况，适应症等等。首先是MRC背后的哲学：89%的就诊儿牙患者有牙列不齐的问题，原因可能是食物太软了，老师建议是每天至少有15分钟吃需要用力咀嚼的食物。牙齿">
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          <h1 class="post-title" itemprop="name headline">MRC培训记录</h1>
        

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        <p>昨晚公司请MRC公司（全称是myobrace）的欧大明(Damien O’Brien)老师来进行了MRC的培训，记录一下。以下为我个人记录，不一定代表老师和MRC公司观点（因为是通过同传的）。<br>MRC之前当然也听过，从来没深入了解过，也不知道具体情况，适应症等等。<br>首先是MRC背后的哲学：89%的就诊儿牙患者有牙列不齐的问题，原因可能是食物太软了，老师建议是每天至少有15分钟吃需要用力咀嚼的食物。牙齿不齐与“牙齿不齐”的关系不大，主要原因是口呼吸，舌头位置不正确以及唇肌的问题。舌头的自然位置是舌尖舔上颌前牙腭侧的位置。用口呼吸会使气道变小，血液含氧量降低。牙齿排列不齐更多的是后天发育的问题，而不是先天的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0111%E2%80%94%E2%80%94MRC/01.png"><br>MRC接诊的标准流程是：①诊室里全天滚动播放宣传视频，初诊患者及家长在见到医生前先由工作人员进行15分钟宣教，注意不要在有牙椅的环境中进行；②然后见医生，初查，5分钟，拍片；③再见医生，详细检查，不超过15分钟。<br>遵循这个流程，成功率会从15%提高到85%。<br>MRC的治疗目标：<br>①建立鼻呼吸，即使在睡眠时。<br>②正确的舌头位置。让孩子做两个练习。看到窗子门就问自己”舌头在哪里”，”呼吸在哪里”？<br>如果怀疑鼻部呼吸有障碍，观察孩子进行一分钟的鼻呼吸，如果没有问题，就没问题。如果有问题，去看耳鼻喉医生。<br>另外要检查舌系带的问题。<br>③正确的吞咽。<br>④正确的唇部位置。<br>首先医生要知道这些目标，另外要让患者知道这些目标。<br>只要肌肉活动是正确的，错颌畸形就会改善，否则，正畸效果容易反弹。移动牙齿只要2g的力量，而唇肌可能有800g的力量。<br>对初学者的建议：<br>从6-9岁患儿开始，开合，牙列不齐的。<br>评估呼吸:轻，没有声音。<br>干燥嘴唇，呼吸习惯差，浅呼吸，有呼吸音，深眼袋。<br>评估舌头位置。<br>评估吞咽，牵拉口角，咬合，吞咽，应该什么都看不见。如果看到舌头，就是错的。<br>吞咽时唇部如果运动，也是不对的。<br>移动牙齿只要2g的力，唇肌可能有800g的力量。<br>要在无意识情况下观察。</p>
<hr>
<p>以下就不是培训内容，是我自己查的了。<br>查一下文献吧：</p>
<ol>
<li>Ahn ES, Kim AH, Shim YS, An SY. Oropharyngeal Airway Three-dimensional Changes after Treatment with Myobrace in Class II Retrognathic Children. Iran J Public Health. 2017;46(2):265-267.<br>这是用CBCT证实了用MRC能增大气道开放程度<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0111%E2%80%94%E2%80%94MRC/02.png"></li>
<li>Homem MA, Vieira-Andrade RG, Falci SG, Ramos-Jorge ML, Marques LS. Effectiveness of orofacial myofunctional therapy in orthodontic patients: a systematic review. Dental Press J Orthod. 2014;19(4):94-9.<br>这篇综述了现有的肌功能整塑与正畸治疗联合应用达到更好效果的文献，支持这一观点。但是纳入文献量太少（4篇），而且偏倚较高。</li>
<li>Liyana Tanny, Boyen Huang*, Noel Ye Naung, Geoffrey Currie.  Non-orthodontic intervention and non-nutritive sucking behaviours: A literature review.  Kaohsiung Journal of Medical Sciences (2018) 34, 215e222.<br>本文综述了2000年1月到2017年6月发表的用正畸和非正畸方法干预前牙开合(Anterior open bite, AOB)的研究，AOB是最复杂的错颌畸形之一，治疗反弹率很高。作者结论是口颌面肌功能治疗(Orofacial myofunctional therapy, OMT）和非正畸干预(non-orthodontic intervention, NOI）可以联合应用以提高AOB治疗的疗效。<br>也只是纳入了4篇研究。讨论，病例的长期持续效果还不理想。还需要更多的高质量的研究。<br>看看厂家提供的材料，以下均来自厂商网站：<a target="_blank" rel="noopener" href="https://myobrace.com/en-au">https://myobrace.com/en-au</a><br><a target="_blank" rel="noopener" href="http://myoresearch.com/images/uploads/resources/MYO_PRO_ENG_WEB.pdf">http://myoresearch.com/images/uploads/resources/MYO_PRO_ENG_WEB.pdf</a><br>固定正畸的问题：复发，釉质损伤，牙根损伤。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0111%E2%80%94%E2%80%94MRC/03.png"><br>MRC的基础关键点是达到正确的鼻呼吸，正确的舌头休息位置，以及促使口腔肌肉正确的行使功能。除此之外，Myobrace还可以对牙齿有轻微的力量协助牙齿排齐到它们的自然位置，通常不需要托槽等附加组件。每天只要戴1-2小时，然后睡觉的时间全程佩戴。成功的治疗需要患者的耐心和配合。一般有3-4个阶段。<br>对幼儿的(3-6岁）：<br>J1:习惯纠正，建立鼻呼吸。4-6个月。<br>J2:牙弓发育，建立正确的舌的位置。4-6个月。<br>J3:颌骨对齐和阻挡。4-6个月。<br>对儿童的(6-10岁):<br>K1:习惯纠正，建立鼻呼吸。4-6个月。<br>K2:牙弓发育，建立正确的舌的位置。4-6个月。<br>K3:最终对齐和阻挡。保持正确的唇部位置和吞咽位置。4-6个月。<br>对青少年(10-15岁):<br>T1：习惯纠正，建立鼻呼吸。4-6个月。<br>T1 BWS：牙弓发育，建立鼻呼吸和正确的牙弓形式。<br>T2：建立正确的舌位置，唇位置和吞咽位置。4-6个月。<br>T3：牙列对齐，在习惯和肌功能良好以后，排齐牙齿。 4-6个月。<br>T3N：功能同上。<br>T4:保持。在维持正确的习惯的同时保持牙列对齐。4-6个月。<br>对成人(15岁以上），分A1-A3三个阶段，功能和时间类似。<br>还有一些唇发育训练器，扩弓附件等等。</li>
</ol>
<p>通过这次培训，了解了MRC的原理，功能，治疗目标，时间等内容，但是要具体在临床上上手，可能还要报班学或者看书吧。<br>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“好看”。谢谢。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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